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WALMART PHARMACY 10-5169
DSH450755 Methodist Hospital Levelland (DBA Covenant Hospital Levelland)
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Covered Entity Details
Entity Name
Methodist Hospital Levelland (DBA Covenant Hospital Levelland)
Subdivision Name
Type
Disproportionate Share Hospital
340B ID
DSH450755
Entity Address
1900 COLLEGE AVE
LEVELLAND, TX 79336
Medicare Provider Number
450755
Participating Start Date
7/1/2011
Last Recertification Date
9/13/2024
Pharmacy Details
Pharmacy Name
WALMART PHARMACY 10-5169
Pharmacy Address
2252 NORTH 8TH STREET
SUITE A
ROGERS, AR 72756
Pharmacy Comments
Contract Details
Approval Date
10/17/2023
Contract Begin Date
1/1/2024
Carve-In Effective Date
Contract Comments
Contacts
Covered Entity Signing Official
Jennifer Bryan, CFO
(806) 296-4265
Contract Pharmacy Representative
Walmart
Julie Howard, 340B Program Manager
(479) 277-1498
Signed By Date
10/17/2023
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